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Medical Council of Canada MCCQE Part 1 Exam Sample Questions (Q210-Q215):

NEW QUESTION # 210
A 36-year-old woman presents to the office with a 2-month history of multiple asymptomatic bumps on her vulva. She is not currently sexually active but has had 2 male sexual partners in the past, with the most recent relationship ending 1 year ago. On examination, she appears to have genital warts. She has not received the human papillomavirus (HPV) vaccine and is not interested in any treatment that is not absolutely necessary.
Which of the following is the best next step?

A. Cryotherapy.
B. HPV vaccine.
C. Excisional biopsy.
D. Papanicolaou test.
E. Contact tracing.

Answer: B

Explanation:
The patient has clinical evidence of genital warts (condyloma acuminata), which are caused by low-risk HPV types. Even though she is not currently sexually active and has visible warts, HPV vaccination is still beneficial for protection against other oncogenic strains (especially types 16 and 18). Vaccination is safe and recommended up to age 45.
Toronto Notes 2023 - Gynecology, "STIs and HPV":
"Vaccination is recommended up to age 45, regardless of prior exposure or visible warts. It may prevent reinfection with or acquisition of high-risk HPV strains." MCCQE1 Objectives (Gynecology > 83-3: STIs and HPV):
"Candidates must counsel patients appropriately on prevention, including the role of HPV vaccination, even after exposure or infection." Pap testing (B) is routine screening, not management of visible warts. Cryotherapy (D) is optional if the patient desires removal, but she declined treatment. Biopsy (A) is reserved for atypical lesions. Contact tracing (E) is not typically required for HPV warts.

NEW QUESTION # 211
A 17-year-old boy is brought by his 2 roommates to the emergency department (ED) after a party where he had been drinking and smoking cannabis. He reportedly was having a good time when he suddenly wanted to jump out of a window. His roommates describe him as "normal prior to a breakup with his girlfriend a week ago." He has since become anxious and unable to sleep. On examination, he is somnolent and appears intoxicated. Which one of the following is the most appropriate initial management?

A. Prescribe chlordiazepoxide and start an intravenous line.
B. Arrange for an involuntary admission to psychiatry.
C. Call the patient's parents to take him home.
D. Observe the patient in the ED for several hours.

Answer: B

Explanation:
This adolescent exhibited acute suicidal behavior (attempted to jump out of a window), which is a psychiatric emergency. Regardless of intoxication or cause, such behavior mandates a safety-first approach: involuntary psychiatric assessment and protection from self-harm.
Toronto Notes 2023 - Psychiatry, "Suicide and Crisis Intervention" Section:
"Involuntary psychiatric admission is indicated when a patient poses a danger to themselves or others.
Suicidal ideation or attempts require immediate evaluation and monitoring." MCCQE1 Objectives (Psychiatry > 79-2: Suicide and Risk Management):
"Candidates must identify suicidal behavior and initiate appropriate action, including involuntary admission if necessary for safety." Observation (B) may miss the window for action. Parents (A) should be contacted but are not a substitute for admission. Chlordiazepoxide (C) is not first-line in this scenario.

NEW QUESTION # 212
A 4-month-old boy is brought to the office by his parents to ask about the rotavirus vaccine. They would like to avoid the possibility of the infant coming down with gastroenteritis. Their older child was hospitalized with gastroenteritis at age 10 months. They have a friend who had intussusception after getting the rotavirus immunization, and they are worried about a possible link to the vaccine. Which one of the following is the most appropriate response?

A. Rotavirus infection is generally self-limited, so routine vaccination is not encouraged unless there are comorbidities.
B. The vaccine is recommended as the risk of intussusception is extremely low.
C. The risk of intussusception is markedly increased after vaccination but is offset by a decrease in severe diarrhea.
D. Intussusception is an easily treatable condition.
E. Intussusception only occurs in 1- to 3-year-old children, so any risk to the infant is minimal.

Answer: B

Explanation:
The most appropriate response is to recommend vaccination and explain that the risk of intussusception after rotavirus vaccination is extremely low , while the benefits in preventing severe rotavirus gastroenteritis are substantial. MCCQE objectives in immunization and preventive pediatrics emphasize balancing risks and benefits using evidence-based data. Current rotavirus vaccines are associated with a very small increased risk of intussusception (on the order of a few additional cases per 100,000 vaccinated infants), but this risk is far outweighed by the prevention of hospitalizations, severe dehydration, and complications from rotavirus infection.
Option B overstates the risk as "markedly increased," which is inaccurate and may heighten parental anxiety.
Intussusception is not always easily treatable and can be serious (C). It occurs most commonly in infants under 1 year, not only in 1- to 3-year-olds (D). Rotavirus can cause significant morbidity in healthy infants, so routine vaccination is recommended (E). Clear, balanced counselling supports informed parental decision- making.

NEW QUESTION # 213
A 22-year-old woman presents to the office for episodic mood changes that her boyfriend has noticed. During such episodes, she cries suddenly, is irritable and sad, and withdraws from socializing. Which one of the following would be most useful in establishing a diagnosis?

A. Urine drug screen.
B. Trial of lorazepam.
C. Personality testing.
D. Mood journal.
E. Interviewing the boyfriend alone.

Answer: D

Explanation:
A mood journal is a structured tool that allows the patient to record mood fluctuations, triggers, and timing. It is particularly helpful in identifying mood disorders such as premenstrual dysphoric disorder, bipolar disorder, or cyclothymia.
Toronto Notes 2023 - Psychiatry, Mood Disorders:
"Mood diaries are useful in identifying temporal patterns, such as menstrual cycle-linked mood changes, and in distinguishing between affective disorders." MCCQE1 Objectives - Psychiatry > Diagnostic Evaluation:
"Candidates should use clinical tools such as symptom diaries to assist in establishing the pattern and nature of psychiatric symptoms." Personality testing (A) is not first-line. Urine drug screen (B) is only indicated with suspicion of substance use. Lorazepam (D) treats symptoms, not diagnosis. Interviewing the boyfriend (E) may help, but only as a supplement to direct observation and self-report.

NEW QUESTION # 214
A 45-year-old man presents to your clinic for follow-up regarding his obsessive-compulsive disorder. He currently takes a high dosage of paroxetine, which he would like to discontinue because he feels well. His condition has been stable taking this medication since he was discharged from inpatient care 2 years ago.
Which one of the following is the most appropriate recommendation?

A. Reduce the dosage of paroxetine by 50%.
B. Discontinue paroxetine and refer for supportive psychotherapy.
C. Switch paroxetine to sertraline.
D. Maintain the current dosage of paroxetine.

Answer: D

Explanation:
Obsessive-compulsive disorder (OCD) is a chronic and often relapsing condition. MCCQE objectives emphasize that patients with severe OCD requiring hospitalization or prolonged high-dose SSRI therapy are at significant risk of relapse if medication is discontinued. This patient has remained stable for 2 years on a high dose of paroxetine after inpatient treatment, suggesting a history of more severe disease.
For moderate-to-severe or recurrent OCD, long-term or indefinite maintenance pharmacotherapy is often recommended, particularly when the patient has responded well and tolerated the medication. Abrupt discontinuation or large dose reductions (e.g., 50%) increase the risk of relapse and discontinuation syndrome, especially with paroxetine, which has a short half-life. Switching to another SSRI is unnecessary when the current medication is effective and tolerated. Supportive psychotherapy alone is generally insufficient for patients with previously severe OCD.
Therefore, the most appropriate recommendation is to maintain the current dosage , while discussing risks and benefits and reassessing periodically.

NEW QUESTION # 215
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